Zhengjun Li1, Wei Chen2, Mozhu Xia3, Hongxu Liu2, Yongyu Liu1, Ilhan Inci4, Fabio Davoli5, Ryuichi Waseda6, Pier Luigi Filosso7, Abby White8. 1. Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China. 2. Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China. 3. Department of Thoracic Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China. 4. Department of Thoracic Surgery, University Hospital, University of Zurich, Zurich, Switzerland. 5. Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy. 6. Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan. 7. Unit of Thoracic Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy. 8. Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND: The purpose of this meta-analysis was to evaluate evidence comparing sleeve lobectomy (SL) and pneumonectomy (PN) in the treatment of non-small cell lung cancer (NSCLC). METHODS: The English literature search was undertaken in January 2018 and included studies dating back to 1996. Comparative studies were identified, evaluating survival, local recurrence, and distant recurrence rates, operative mortality, 30-day mortality, as well as complications. A pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated with either the random or fixed-effect model. RESULTS: A total of 27 studies were identified, with publication dates between 1996 and 2018. These 27 studies included a total of 14,194 patients: 4,145 treated with SL and 10,049 treated with PN. The overall survival was significantly higher in the SL group compared to the PN one at 1, 3, 5 years. In patients with N0 and N1 disease, 5-year survival rates following SL exceeded those following PN. There was no statistically significant difference in the 3-, 5-year overall survival of N2 patients, according to the extent of surgery. The PN group had a higher rate of operative mortality, 30-day mortality and distant recurrence incidence. However, no statistical difference in complications and local recurrence between SL and PN were observed. CONCLUSIONS: SL is an effective treatment option for hilar NSCLC with improved long-term survival compared to PN, with no increase of recurrence rate or postoperative complications. Furthermore, N2 disease is an important factor related to survival, and lymph node downstaging is a favorable prognostic factor. 2019 Translational Lung Cancer Research. All rights reserved.
BACKGROUND: The purpose of this meta-analysis was to evaluate evidence comparing sleeve lobectomy (SL) and pneumonectomy (PN) in the treatment of non-small cell lung cancer (NSCLC). METHODS: The English literature search was undertaken in January 2018 and included studies dating back to 1996. Comparative studies were identified, evaluating survival, local recurrence, and distant recurrence rates, operative mortality, 30-day mortality, as well as complications. A pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated with either the random or fixed-effect model. RESULTS: A total of 27 studies were identified, with publication dates between 1996 and 2018. These 27 studies included a total of 14,194 patients: 4,145 treated with SL and 10,049 treated with PN. The overall survival was significantly higher in the SL group compared to the PN one at 1, 3, 5 years. In patients with N0 and N1 disease, 5-year survival rates following SL exceeded those following PN. There was no statistically significant difference in the 3-, 5-year overall survival of N2 patients, according to the extent of surgery. The PN group had a higher rate of operative mortality, 30-day mortality and distant recurrence incidence. However, no statistical difference in complications and local recurrence between SL and PN were observed. CONCLUSIONS: SL is an effective treatment option for hilar NSCLC with improved long-term survival compared to PN, with no increase of recurrence rate or postoperative complications. Furthermore, N2 disease is an important factor related to survival, and lymph node downstaging is a favorable prognostic factor. 2019 Translational Lung Cancer Research. All rights reserved.
Authors: H A Gaissert; D J Mathisen; A C Moncure; A D Hilgenberg; H C Grillo; J C Wain Journal: J Thorac Cardiovasc Surg Date: 1996-05 Impact factor: 5.209
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